Applicant’s Name *

First

Last

Date of Birth *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Cell Phone *

Email *

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Employed By *

Work Phone *

Employer’s Address:

Address Line 1

Address Line 2

City

State

Zip Code

Do you know any members of the Fairhope Fire Dept?

Please list their name(s) *

Marital Status

Spouse’s Name *

First

Last

Emergency Contact Name *

First

Last

Emergency Contact Number *

Your Blood Type:

If needed, are you willing to donate blood?

Do you have any physical disabilities? *

Do you have any physical limitations that would prevent you from performing duties as a firefighter? f so, please explain below

Physical limitations explained

Do you have or have you had any of the following? *

Have you had recent surgery? *

Please list any recent surgeries that would affect your ability to perform the physical duties of a firefighter. If none, type none.

Do you have any allergies? *

Please list any allergies. If none, type none.

It may be required of you to take and PASS a physical examination, which includes a Drug Screen Test prior to becoming a Firefighter. Are you willing to comply with this? *

Do you have a Police Record? *

please explain: *

Do you hold a current Alabama Drivers License?

Driver’s License #

Driver’s License Class(s):

Have you ever had a driver’s license suspended or revoked?

Have you ever had traffic violations for the following

Speeding
Reckless Driving
DWI or DUI
Running stop sign or light

Have you ever taken Defensive Driving?

If yes, Date Taken:

Have you ever taken Driver’s Training?

If yes, Date Taken:

Do you have any additional training? Please explain.

Examples are EMT, CPR, First Aid, Lifeguard, Military, Law Enforcement, or Fire Fighting training, etc

Have you ever belonged to a fire department?

If yes, where and when?

Do you understand that you will be called on at all hours when needed if you are accepted for membership? *

Please write a brief paragraph stating why you wish to become a member of the Fairhope Volunteer Fire Department and what talents you possess that would benefit the organization

How did you hear about joining the Department?

Do you understand that a background check will be performed prior to your application being read? *

I understand

I understand that, if accepted, I will be placed on a six (6) month probationary period and agree to comply with all department policies, procedures, and decisions. I acknowledge that my membership may be terminated in accordance with department bylaws and the decision of the governing body. I further understand that a background review may be conducted, including verification of my law enforcement record, employment history, prior fire service experience, and other relevant information, in compliance with applicable laws prior to my application being presented to the members. By submitting this application, I certify that I have read and understand all questions, and that all information I have provided is true and complete to the best of my knowledge.

FVFD Membership Application

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